Antimicrobial sensitivity pattern and clinical outcome of Neonatal sepsis: A study at tertiary care hospital in Kashmir, J & K, India

Background: Neonatal sepsis contributes significantly to morbidity and mortality among young infants. Neonatal mortality in developing countries is usually due to an infectious cause. The gold standard of investigation in developing countries is a positive blood culture. It is important to know the aetiology of neonatal bloodstream infections so that empirical treatment can be effective. Methods: We conducted a retrospective clinical study over one year between April 2014 until March 2015, looking at the aetiology of both early and late onset neonatal sepsis. We analysed data from 362 (26.6%) culture proven sepsis patient isolates out of 1360 suspected cases of neonatal sepsis. Blood samples were cultured on MacConkey, blood and chocolate agars and bacteria were identified based on characteristic morphology, gram stain appearance and standard commercially prepared biochemical tests. Antimicrobial sensitivity testing was performed for ampicillin, cloxacillin, gentamicin, amikacin, cefuroxime and ceftriaxone. Results: Culture proven sepsis was noted in 26.6% (362/1360) of the study participants. Isolated bacterial pathogens were predominantly Cogulase Negative Staphylococcus aureus(26.79%),followed by Klebsiellaspp(12.98%) and Acinitobactor species(11.87%). Resistance of blood culture isolates was high to ampicillin 77.7% (280/362) and cloxacillin 70.1% (254/362)), moderate to ceftriaxone 14.91% (54/362) and cefuroxime 19.88% (72/362), and low to amikacin 2.2% (8/362). The overall neonatal mortality was 13.97% (190/1360), being higher in neonates with sepsis 90/362 (24%) as compared to those without 100/998 (10%). Conclusions: Cogulase Negative Staphylococcus aureus was predominant isolate followed by Klebsiella and Acinitobactor species. There was high resistance to ampicillin and cloxacillin. Mortality rate due to neonatal sepsis was high in our setting. Routine antimicrobial surveillance should guide the choice of antibiotics for empirical treatment of neonatal sepsis.